ENDOMETRIOSIS FOUNDATION
OF HOUSTON
Managing endometriosis
Approaches to Managing Endometriosis
Approaches to managing endometriosis generally fall into 3 categories.
1. Medical management: Medications used to manage symptoms, including pain and hormone-related drugs.
2. Surgical management: Procedures intended to identify and remove or otherwise treat endometriosis lesions.
3. Complementary care: Supportive approaches such as pelvic floor physical therapy, psychological support, and other complementary therapies that may help manage symptoms and improve quality of life.
Each approach has potential benefits, limitations, and risks. Discuss your options with your healthcare provider before starting treatment, and ask questions about the expected benefits, possible side effects, long-term considerations, and alternatives. Finding an approach that works for you may involve combining treatments and adjusting your care plan over time.
1. Medical Management
Medications are commonly used to manage endometriosis-associated symptoms, but it is important to understand the distinction between managing symptoms and treating the disease itself. Currently, available medications do not cure endometriosis or prevent the disease from progressing. Some medications may reduce pain and other symptoms, but symptom improvement does not necessarily mean that the underlying disease has resolved.
Hormonal medications are often prescribed to patients with endometriosis. These include combined oral contraceptive pills, progestin-only medications, Depo-Provera injections, intrauterine devices (IUDs), and gonadotropin-releasing hormone (GnRH) agonists and antagonists like Lupron and Orilissa which induce chemical menopause. These treatments may help reduce pain and other symptoms for some patients. However, their benefits, side effects, and recommended duration of use vary. Some, particularly GnRH medications, may require specific precautions or additional medication to help manage challenging side effects, including potential bone density loss and mood changes. Discuss the risks, benefits, and long-term considerations of each option with your healthcare provider.
2. Surgical Management
Endometriosis surgery is commonly performed using laparoscopy, a minimally invasive approach that uses small incisions in the abdomen and belly button and a camera to examine the pelvic and abdominal cavities. Laparoscopic surgery may be performed using traditional instruments or robotic-assisted technology.
Not all surgeries are equal. A surgeon's training and experience make an important difference in outccomes. Unfortunately, most OBGYNs do not have the extensive surgical training required to treat endometriosis.
Learn about excision surgery here.
A hysterectomy is not a cure for endometriosis. Although hysterectomy may be appropriate for some patients, removing the uterus does not remove endometriosis lesions elsewhere in the body. Endometriosis can occur in people who have had a hysterectomy, and symptoms may persist if disease is left behind. Treatment decisions should be individualized and based on informed discussions about the benefits, risks, alternatives, and the patient's goals. A hysterectomy should not be presented as the only option for long-term management of endometriosis.
3. Complementary Care
Although excision surgery is the gold standard of care for endometriosis, access to skilled surgeons may be limited by financial barriers and provider availability. Additionally, longstanding endometriosis-associated pain can contribute to changes in the nervous system, pelvic floor dysfunction, and other overlapping conditions that may not resolve with surgery alone.
A multidisciplinary approach can help address the different ways endometriosis affects a person's health and quality of life. Depending on individual needs, supportive care may include pelvic floor physical therapy, psychological support, nutrition counseling, acupuncture, pain management, and other complementary therapies.
These approaches may help manage symptoms, address overlapping conditions, improve function, and support overall well-being. While they do not treat the disease itself, they can be valuable components of a comprehensive care plan.
Pelvic Floor Physical Therapy
Endometriosis is a systemic disease, impacting the whole body and contributing to overlapping sources of pain. The body responds to chronic pain by reflexively tightening muscles in and around the painful area. Over time, this protective response contributes to pelvic floor muscle tension, restricted movement, and dysfunction. These changes then become an additional source of pain layered on top of endometriosis itself.
Pelvic floor physical therapists are specially trained to assess and treat pelvic floor dysfunction. Depending on your individual needs, treatment may include techniques to relax tense muscles, improve muscle coordination, address mobility restrictions and scar tissue, and support healthy movement and circulation. Pelvic floor physical therapy can also help improve bladder, bowel, and sexual function. It is also an important tool to help calm an overactive nervous system and pain response.
Psychotherapy
Many people with endometriosis have been told that their symptoms are “all in their head.” So, the idea of seeking therapy may feel frustrating or even invalidating. It is important to understand that seeking mental health support does not mean your symptoms are imagined or that your pain is any less real.
Living with endometriosis can take a significant emotional toll. Chronic pain, diagnostic delays, medical trauma, isolation, uncertainty, and disruptions to relationships, work, education, and daily life can contribute to anxiety, depression, grief, and stress. These responses are understandable, and you deserve support in navigating them.
A therapist who understands chronic illness or chronic pain can help you develop coping strategies, navigate difficult emotions, manage stress, and improve your quality of life. While mental health support is not a substitute for appropriate medical care, it is another way to care for yourself while navigating the challenges of endometriosis.
